MEDICARE: YUSUF SOBOLA FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F356370-01	NY

General Provider Information

NPI Number	:	1255269445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUSUF SOBOLA FNP-BC

Provider Business Mailing Address
First Line	:	16 S 9TH AVE APT 1
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-6107
Country	:	US
Telephone Number	:	716-812-6877
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 S 9TH AVE APT 1
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-6107
Country	:	US
Telephone Number	:	716-812-6877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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